Nursing Care Plan Ineffective Health Maintenance

Nursing Care Plan Ineffective Health Maintenance, NANDA Definition: The inability to identify, manage, or seek out help to maintain healt. Defining Characteristics Ineffective Health Maintenance: History of lack of health-seeking behavior; reported or observed lack of equipment, financial, and/or other resources; reported or observed impairment of personal support systems; expressed interest in improving health behaviors; demonstrated lack of knowledge regarding basic health practices; demonstrated lack of adaptive behaviors to internal and external environmental changes; reported or observed inability to take responsibility for meeting basic health practices in any or all functional pattern areas, above definition picture Nursing Care Plan Ineffective Health Maintenance

Related Factors: Disabled family coping, perceptual-cognitive impairment (complete or partial lack of gross or fine motor skills); lack of or significant alteration in communication skills (written, verbal, or gestural); unachieved developmental tasks; lack of material resources; dysfunctional grieving; disabling spiritual distress; inability to make deliberate and thoughtful judgments; ineffective coping

DEFINITION

  • Inability to identify, manage, and/or seek out help to maintain health

DEFINING CHARACTERISTICS

  • Demonstrated lack of adaptive behaviors (internal or external environmental changes)
  • Demonstrated lack of knowledge regarding basic health practices
  • History of lack of health-seeking behaviors
  • Reported or observed impairment of personal support systems
  • Reported or observed inability to take responsibility for meeting basic health practices in any or all functional pattern areas.
  • Reported or observed lack of equipment or financial and other resources

RELATED FACTORS

  • Cognitive impairment
  •  Diminished gross motor skills
  • Complicated grieving
  •  Inability to make appropriate
  •  Deficient communication skills judgments
  •  Diminished fine motor skills
  •  Ineffective family coping

ASSESSMENT FOCUS

  • Communication
  • Knowledge
  • Coping
  • Risk management
  • Healthcare system
  • Values and beliefs

EXPECTED OUTCOMES

The patient will

  • Maintain current health status
  • Sustain no harm or injury
  • Verbalize feelings and concerns
  • Explain health maintenance program
  • Identify available health resources.

SUGGESTED NOC OUTCOMES

Coping; Decision Making; Health Beliefs: Perceived Resources; Health-Promoting Behavior; Social Support; Spiritual Health

INTERVENTIONS AND RATIONALES

Determine: Assess current health status; personal habits such as use of tobacco, drugs, and alcohol; level of knowledge about disease process; level of family and community assistance; coping mechanisms and communication skills (verbal and written); and degree of motivation to maintain health. Assessment factors will assist the nurse in establishing interventions for this diagnosis. Perform: Provide assistance with self-care, as needed. Encourage increasing levels of independence. The patient should be as independent in ADLs as possible.167 Administer medications as prescribed to ensure continuation of

therapy.Adapt environment to that which is best suited to the particular patient. Reorient the patient as needed. In the disoriented patient,reorientation should take place frequently to keep the person as close to knowing person, place, and time as possible.Provide a consistent caretaker whenever possible to promote sta- bility for the patient.Plan a health maintenance program for patient and family members addressing current disabilities. Provide patient and family with a writ- ten copy. Giving instructions in writing will reinforce the various aspects of the program and increase the possibility of compliance. Inform: Fully describe all aspects of the patient’s care to the family to elicit cooperation from them in continuing a plan.Instruct family members how to carry out health maintenance practices. Demonstrate skills such as bathing, feeding, and reality orientation; then, have family members return demonstration under supervision. Involving family members allows them the opportunity to perform skills and solve problems with support and supervision.Provide specific instructions on how to maintain a safe
environment for the patient to avoid falls and other types of accidental injuries Teach relaxation techniques (e.g., guided imagery, progressive mus-cle relaxation, and meditation) that can be done by the patient andthe family to enhance coping ability and restore psychological and
physical equilibrium by decreasing autonomic response to anxiety.Attend: Encourage patient and family to verbalize feelings and con-
cerns related to health maintenance. This promotes better understanding and greater ease in managing challenging situations.Demonstrate willingness to repeat instruction and demonstrate skills needed to care for the patients until they feel comfortable.Manage: Refer to social and community resources, such a stroke sup-port group, and Alzheimer’s family support group. This helps the family gain support and receive factual information. It provides opportunity to express feeling in a group where others are experiencing similar issues.Making referrals is appropriate to mental health professional to assist with prevention of burnout for the family.

SUGGESTED NIC INTERVENTIONS

Anticipatory Guidance; Coping Enhancement; Counseling; Discharge Planning; Health Education; Health System Guidance; Physician Support; Referral; Support System Enhancement

Reference

  • Cole, C. S., et al. (2006, April). Assessment and discharge planning for the
  • older hospitalized adults with delirium. Medsurg Nursing, 15(2), 71–76.
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